Analysis of clinical factors associated with intraoperative and postoperative complications of retrograde intrarenal surgery

2021 ◽  
pp. 1-12
Author(s):  
Cuneyt Ozden ◽  
Cetin Volkan Oztekin ◽  
Sahin Pasali ◽  
Samet Senel ◽  
Doruk Demirel ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Solitary Kidney ◽  
Classification Systems ◽  
Retrograde Intrarenal Surgery ◽  
Intraoperative Complication ◽  
Factors Affecting ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Residual Stones

Abstract The aim of this study was to evaluate the factors affecting intraoperative and postoperative complications in retrograde intrarenal surgery. In the retrospective cohort study, 706 retrograde intrarenal surgery procedures applied to 617 patients were reviewed. Intraoperative and postoperative complications were classified according to the modified Satava and modified Clavien classification systems. The stone-free rate was 57.6% and the success rate was 74.8%. Intraoperative complications were observed in 30.5% (n:215) patients. The most common intraoperative complication was mild bleeding (8.5%). The only independent risk factor associated with intraoperative complications was the presence of residual stones. Postoperative complications were observed in 26.9% (n:190) of the patients. The most common postoperative complications were fever requiring antipyretic (8.6%). Independent risk factors associated with postoperative complications were the presence of residual stones and the presence of solitary kidney. Continuous...

scholarly journals Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

2019 ◽  
pp. 219256821989522
Author(s):  
So Kato ◽  
Taylor Dear ◽  
Stephen J. Lewis
Keyword(s):  
Body Weight ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Fluid Administration ◽  
Prolonged Stay ◽  
Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

scholarly journals Factors affecting colistin nephrotoxicity: Advanced age and/or other factors?

2021 ◽  
Author(s):  
Tugba Arslan Gülen ◽  
Ayfer Imre ◽  
Uner Kayabas
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Geriatric Patients ◽  
Advanced Age ◽  
Factors Affecting ◽  
Factors Associated ◽  
Independent Risk Factors

Introduction: The population is aging and older adults comprise the majority of patients in intensive care units. Colistin (COL) has been reintroduced to treat increasingly common resistant Gram-negative bacterial infections. Our study aims to investigate the factors affecting colistin nephrotoxicity in the general population and geriatric age group. Materials and Method: This retrospective study included 170 patients, 116 (68.2%) of which were in the geriatric group (age ≥65). Acute renal failure was evaluated using the RIFLE score. Firstly, factors associated with COL nephrotoxicity in the general population were investigated. Then, risk factors for COL nephrotoxicity were evaluated in the geriatric patient group. Results: Advanced age (odds ratio [OR]=1.043; 95% confidence interval [CI]: 1.018-1.068; p=0.001) and initial serum creatinine level (OR=23.122; 95% CI: 3.123-171.217; p=0.002) were found to be independent risk factors associated with nephrotoxicity. In the evaluation of the geriatric population-based on nephrotoxicity, the initial serum urea and creatinine levels, immunosuppression, and overall mortality rates were found to be statistically significant in the group with nephrotoxicity (p<0.05). Initial serum creatinine level (OR=22.48; 95% CI: 2.835-178.426; p=0.003) and concomitant nephrotoxic agent use (OR=2.516; 95% CI: 1.275-4.963; p=0.008) were independent risk factors associated with nephrotoxicity in geriatric patients. Conclusion: Advanced age was found to be a risk factor for COL nephrotoxicity. Caution should be exercised especially in geriatric patients who have initial serum creatinine levels close to the upper limit, concomitant use of nephrotoxic drugs should be avoided and if possible, evaluation should be made in terms of non-COL treatment options in these patients.

scholarly journals Factors Associated with Cataract Surgical Outcomes in a Tertiary Health Facility in Oyo State, Nigeria: A Retrospective Study

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Abiola T. Owolabi ◽  
Susannah T. Adepoju ◽  
Olawale Oladejo ◽  
Kunle I. Oreagba
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Goodness Of Fit ◽  
Intraoperative Complications ◽  
Visual Outcome ◽  
Sub Saharan Africa ◽  
P Value ◽  
Goodness Of Fit Test ◽  
Intraoperative Complication ◽  
Factors Associated

Background: Cataract surgery is the most common operation performed in ophthalmology. It is the commonest cause of reversible blindness globally, in Sub-Saharan Africa and Nigeria. The study examined some factors affecting the outcome of cataracts surgery measured by Visual acuity after 6 weeks. Methods: Data was collected from the records of ophthalmic patients who had cataract surgery at LAUTECH Teaching Hospital Ogbomoso, from the period of January 2013 to December 2018. Two hundred and twenty-seven patients’ records were retrieved for the study. Logistic Regression was used to investigate factors associated with the outcome of Cataracts Surgery. The goodness of fit test was used to determine the fit of the model to the data. Results: Two variables; intraoperative complication, and unaided visual acuity on the fir st postoperative day were statistically significant (p-value < 0.05). The outcome of surgery using unaided visual acuity after six weeks of surgery showed that 47.1% of the patients had a good visual outcome (6/18) or better and 52.9% had a poor outcome (worse than 6/60). Factors such as complications within six weeks, presence of ocular and systemic comorbidity, and presence of intraoperative complications were found to increase the likelihood of poor outcomes in cataract surgery. Conclusion: This study has shown that Intraoperative complications and unaided visual acuity on the first postoperative day are important to the outcome of cataract surgery. Therefore, the two factors should be given attention during cataract surgery

scholarly journals Iris manipulation during phacoemulsification: intraoperative and postoperative complications

2021 ◽  
Vol 14 (5) ◽  
pp. 676-683
Author(s):  
Eric R. Williams ◽  
◽  
D. Claire Miller ◽  
Anne M. Lynch ◽  
Richard S. Davidson ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Cataract Extraction ◽  
Exclusion Criteria ◽  
Intraoperative Complication ◽  
Postoperative Inflammation ◽  
University Of Colorado ◽  
Additional Surgery ◽  
The University ◽  
Complex Cases

AIM: To quantify intraoperative and postoperative complications in complex phacoemulsification cataract extraction (phacoemulsification) with iris manipulation compared to non-complex and complex phacoemulsification without iris manipulation. METHODS: All phacoemulsification cases at the University of Colorado between January 1, 2014, and June 30, 2017 were included. Exclusion criteria for the primary outcome of intraoperative complications were planned combination surgery and eyes with less than 28d follow-up. Exclusion criteria for the secondary outcomes of postoperative complications were unplanned additional surgery, and chronic steroid eye drop use prior to surgery. Data including sex, race/ethnicity, surgery length, visual acuity, intraoperative and postoperative complications, and intraocular pressures (IOP) were collected and analyzed utilizing general linear and Logistic regression modeling. RESULTS: The medical records of 5772 eyes were reviewed (500 complex without iris manipulation, 367 with iris manipulation). The number of any intraoperative complication in the complex with iris manipulation and complex without iris manipulation groups was 15 (4.1%) and 26 (5.2%), respectively, compared to 41 (0.8%) in the non-complex group. Postoperative inflammation was found in 135 (2.8%) non-complex cases, 20 (4.1%) complex cases without iris manipulation, and 20 (5.6%) complex cases with iris manipulation. The adjusted odds ratio of postoperative inflammation in phacoemulsification with iris manipulation compared to non-complex was 2.3 (95%CI: 1.3-4.0, P=0.005). The rate of IOP spikes &#x003E;10 mm Hg was significantly greater in cases with iris manipulation (P=0.001). CONCLUSION: Complex cases have more intraoperative complications. However, only complex cases with iris manipulation led to increase rates of postoperative inflammation and IOP spikes &#x003E;10 mm Hg.

scholarly journals Complications of robot-assisted and laparoscopic partial nephrectomy

2021 ◽  
Vol 17 (2) ◽  
pp. 34-45
Author(s):  
S. A. Rakul ◽  
K. V. Pozdnyakov ◽  
R. A. Eloev
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Laparoscopic Approach ◽  
High Complexity ◽  
Robot Assisted ◽  
Kidney Tumors ◽  
Intraoperative Complication ◽  
Grade Ii

Objective: to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.Materials and methods. In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.Results. The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.Conclusion. Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.

Bariatric Surgery between Health Need and Complications, Medina 2010-2017

2020 ◽  
Vol 3 (11) ◽  
pp. 758-769
Author(s):  
Ghassan Alsisi ◽  
Lama Shahata ◽  
Mona Abdulaziz ◽  
Ghaidaa Kulaib ◽  
Zainab Alshinqiti ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Health Impact ◽  
Chronic Illnesses ◽  
Good Effect ◽  
Intraoperative Complication ◽  
The Social ◽  
The Mean ◽  
Health Need

Background: Obesity is established worldwide health problem. One of the methods to manage it is bariatric surgery. Our study aim is to determine the complications of bariatric surgery at Medina, KFH from surgical overview and compare the results with other studies.   Objectives: To identify the most common health needs indicating bariatric surgery and the health impact of these procedures on them. And to determine the types of intra and postoperative complications can occur due to bariatric surgery.   Methodology: This is an analytical retrospective study of the patients who underwent bariatric surgery in KFH, Medina, K.S.A, from 2010-2017. Data was gained from the hospital medical records between 8th – 16th April 2018. It had been typed into an excel 2010 program, and statistical analysis done by statistical package for the social sciences (SPSS v.21) for windows. Results: 154 patients underwent bariatric surgery in KFH, 78.6% of them are female and 21.4% are male. The mean BMI is 49.69 ± 9.386. 29.9% of them are previously diagnosed with chronic illnesses HTN 38.7%, DM 30.1%, IHD 2,2%, and others 29.0%. Regarding the type of operation gastric sleeve done approximately 96.1%, adjustable gastric banding approximately 3.3%, Roux en Y gastric bypass approximately 0.7%. With 0.0% intraoperative complication and 3.8% postoperative complications.   Conclusion:In KFH Medina, bariatric surgery had a good effect on gynecological conditions. No mortalities or intraoperative complications. We recommend more studies to study the effect of bariatric surgery on DM and HTN in Medina in a longer period.

Comparing the perioperative management of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in patients with pure seminomatous and nonseminomatous germ cell tumors (NSGCT).

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 230-230
Author(s):  
D. J. Pfister ◽  
J. Busch ◽  
C. Winter ◽  
M. Schrader ◽  
K. Dieckmann ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Germ Cell Tumors ◽  
Laparoscopic Approach ◽  
Retroperitoneal Lymph Node Dissection ◽  
Residual Tumour ◽  
Intraoperative Complication ◽  
Thoracoabdominal Approach ◽  
Retroperitoneal Tumour ◽  
Few Data

230 Background: PC-RPLND is a potentially complicated intervention. By the time the rate of complications and adjunctive surgery increased. Only few data are available concerning PC-RPLND in patients with advanced seminomas and residual retroperitoneal tumour lesions. We examined the intra and postoperative complications as well as the frequency of adjunctive surgeries in patients with seminoma and compared the data to a cohort of patients with NSGCT who underwent PC-RPLND. Methods: In our multicenter retrospective analyses 408 patients underwent PC-RPLND between 1989 and 2010. 47 patients with advanced seminomas and 327 patients with NSGCT. The surgical approach was preferred via a midline incision or a thoracoabdominal approach due to the location of the residual tumour. In one center a laparoscopic approach was preferred. Results: Of the 47 patients with seminoma a total number of 18 adjunctive surgeries were performed in 11 patients (8 nephrectomies, 3 inferior v.cava resections, 3 resections of the abdominal aorta, 2 resections of the colon, one nerv and 2 hepatic resections/biopsies). There was only one major intraoperative complication, injury of the v. cava and two postoperative complications, (prolonged intestinal paralyses). There were no significant differences adjunctive surgeries and postoperative complications (p=0.48 and p=0.133). There were significantly less intraoperative complications in favour of seminomas (p=0.006). Conclusions: PCRLND in seminomas and NSGCT is a demanding surgical intervention. In contrast to other series we did not find significant differences in the two patient groups concerning adjunctive surgeries and postoperative complications. The indication for PCLND in patients with seminoma is limited, but if necessary it can be performed safely in experienced centers. No significant financial relationships to disclose.

scholarly journals The effect of optical dilatation before retrograde intrarenal surgery on success and complications: results of the RIRSearch group study.

2021 ◽  
Author(s):  
Eyup Burak Sancak ◽  
Cem Basatac ◽  
Murat Akgul ◽  
Onder Cinar ◽  
Oktay Ozman ◽  
...  
Keyword(s):  
Success Rate ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Independent Effect ◽  
Multivariable Logistic Regression Model ◽  
Retrograde Intrarenal Surgery ◽  
Residual Stone ◽  
Intraoperative Complication ◽  
Surgical Success ◽  
The Impact

Aims: The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS) in the literature. The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the procedure on the success and complications of RIRS. Methods: In a multicentre retrospective study, 422 patients were included in the study. The patients were divided into two groups according to whether sURS was to be performed. Patients’ demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. Results: Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Operation time in the sURS group was significantly long (p<0.0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (p=0.03). Compared with the non-sURS group, the intraoperative complication rate was low in the sURS group (14 (4.8%) vs 1 (0.8%), p=0.04). The surgical success rate was higher in the sURS group (p=0.002). Nevertheless, sURS had no independent effect on surgical success. We have found two independent predictors for surgical success rate: stone number (p<0.0001, OR:2.28) and failed UAS placement (p=0.035, OR:3.49) Conclusion: Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied in the group of patients who have not been passively dilated with a JJ stent

A Fatal Mycotic Sepsis after Retrograde Intrarenal Surgery: A Case Report and Literature Review

2016 ◽  
Vol 84 (2) ◽  
pp. 106-108 ◽  
Author(s):  
Luca Cindolo ◽  
Francesco Berardinelli ◽  
Pietro Castellan ◽  
Roberto Castellucci ◽  
Fabrizio Pellegrini ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Major Complication ◽  
Solitary Kidney ◽  
Stone Disease ◽  
Septic Complication ◽  
Retrograde Intrarenal Surgery ◽  
Neurological Patient ◽  
Endoscopic Gastrostomy ◽  
First Case ◽  
Tract Infections

Purpose The retrograde intrarenal surgery (RIRS) is a procedure that sees an increase in its use every day and is supported by excellent results in terms of safety and feasibility. We report the first case of fatal mycotic septic complication in a neurological patient for renal stone disease. Case Presentation The case of a woman 44 year-old, with left solitary kidney and history of advanced multiple sclerosis, epilepsy, bedridden and percutaneous endoscopic gastrostomy was described. She was hospitalized for the presence of recurrent lower urinary tract infections. The computed tomography (CT) scan control revealed a 1.7 cm obstructive renal pelvic stone and multiple stones in the bladder. After the refusal of a percutaneous approach, a RIRS was planned and done. No intraoperative complications were observed. In the postoperative period, she developed a urinary sepsis with progressive deterioration of the general conditions. She died 6 days after the RIRS for septic shock with a blood culture positive for Candida glabrata. Discussion A Pubmed search for fatal complications after RIRS shows only two cases not fully elucidated. Conclusions The use of flexible ureteroscopes and holmium lasers has a high succes rate;nevertheless, the possibility of a major complication should be kept in mind in order to evaluate all the risk factors, to adopt all the preventive measures for the safety of the patients.

scholarly journals Factors affecting intraoperative and postoperative complications of RIRS classified by the Clavien and Satava grading systems

2021 ◽  
Author(s):  
Omer Koras ◽  
Ibrahim Halil Bozkurt ◽  
Nihat Karakoyunlu ◽  
Serdar Çelik ◽  
Ertugrul Sefik ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Classification System ◽  
Intraoperative Complications ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Stone Size ◽  
Factors Affecting ◽  
Stone Free Rate ◽  
Free Rate ◽  
Free Status

Objective: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and upper ureteral stones at two institutions between March2015 and June2020. Intraoperative complications were assessed using SCC and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The female/male ratio of 949 patients was found to be 346 (36.5)/603(63.5). The median stone size was determined as 13 mm. The stone-free rate was 83.6%after the first intervention, and the final stone-free rate was 94.4% after re-procedure. According to SCS, the intraoperative event and complication incidence was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.9%, p=0.006). Besides, stone localization, size, number and density were associated with the development of complications (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). In addition, the multivariate analysis revealed that for the patients with grade≥3 complications according to MCCS, only stone-free status was a significant predictor of complication development (p=0.044) whereas for those with grade ≥2b complications according to SCS, significant predictors were stone size (p<0.001), stone density (p=0.022), and fluoroscopy time (p<0.001). Conclusion: This study showed that abnormal kidney anatomy, multiple stones, operative time, and stone-free status were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

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